Cause of Death

The delivery arrives at 7:43 AM. It was scheduled for 7:30 AM. I got to work at 6:30 AM, and readied the autopsy room by the time my second cup of coffee finished brewing. I waited the additional thirteen minutes in irritation–punctuality is important in this field–and listen to an audio message from my mother asking about my date the previous night.

“Natalie, call me back! I want details! Was he handsome? Did he have a job? Did he have all of his teeth?”

I smile, despite it all, and start to call her back to tell her all about my date, the restaurant, how I’m destined to be single forever, when my delivery finally arrives.

The transport tech, a young man of maybe 30, waits patiently at the entrance of my office. He must be new, I think, because I haven’t seen him yet, and he’s bouncing his eyes around like the morgue still makes him uncomfortable.

“Dr. Natalie Bryant? Dr. Okafor said to bring it straight to you…”

“Her,” I correct, already reviewing the transport paperwork. “It is a woman.” A Jane Doe, to be specific. Found in an alleyway yesterday, no ID on scene, and no one recognized her yet. I frown at the tech, sign his papers, and watch him all but run away. How sad it is to be a Jane Doe–to be lost to the people who love you. And then be called an it by a young man with a buzz cut.

Jane is waiting for me in the morgue in a solid black bag. As I begin the preparation of Miss Doe, I make sure to start my voice recorder. Even in the autopsy room, when I’ve created the sterile environment, transported Jane to the sterile autopsy table, suited and gloved, I continue to think out loud what I observe.

“Beginning external examination at 8:52 AM, Tuesday, June 23, 2026. Female, mid-30’s. Olive complexion, black hair.” I have long been ridiculed and praised for my extraordinary attention to detail. Yes, my notes are a mile long–but I am the best medical examiner in the field. Aren’t sure what to think? Call Dr. Bryant. All understudies are told about me and my most famous cases. I briefly consider my niche fame, my practically nonexistent humility, and consider, not for the first time, if this is why I am destined to be single. I always start at the feet, where answers usually aren’t, and make my way to where they usually are. “Approximately 5 foot 6.”

Obviously, all bodies that enter my autopsy room are unclothed. However, I can always tell the specifics.

“Slight calluses on both big toes and heels. Jane spent considerable time on her feet, possibly in her career. No other marks.” She didn’t get to run. I don’t say that in my recording, though they likely heard it in the pitch of my voice. “No marks on ankles or calves. Knees are also unremarkable.” Sorry, Jane. “Birthmark on left thigh, nearly mid thigh, shaped like a…” Machine gun? “Oblong item.”

I move up the abdomen. “No visible scarring.” No surgeries, then, unless it was ages ago. Even still, scars don’t disappear. Jane clearly took care of herself, or tried to. Before whatever happened.

A picture is slowly forming in my mind of my patient. “Patient likely worked in an active role.” Then, her hands. Her hands are curled–they usually are, like even after death, the body is trying to hold onto something. In reality, it is rigor mortis.

Her nails are short, further confirming the theory she worked in a more active role. Possibly healthcare, given the unpainted state. I note the bruising across the knuckles first, yellowish at the edges. “Bruising, dorsal surface, right hand. Knuckles, between thirty-six to forty-eight hours.” I lean in closer, my mask stretching against my mouth. “Abrasion, right index finger. Nail fractured at the midpoint. Offensive wounds.” There are signs of wear, I note as I cast a glance to her other hand, that show she was likely right handed. I move to the left.

The ring fingernail is gone entirely. Not broken, but torn instead, from the base. I reach for my light, lean in, and–yep. There it is, caught in the soft tissue of the nail bed. I reach for my tweezers, and the skin comes out easily–not attached. Not hers.

I bag it for DNA analysis. “Foreign tissue recovered from nail bed of left hand, ring finger. Again, offensive. Patient fought back, or was the aggressor.” An image begins to form in my mind–the movie trailer that often attaches itself to these examinations. A woman on her back, hands gripping the forearms of a man above her. “Bagged.”

I pause. Good for you, Jane.

I move to the forearms. Four marks on the left arm. Three on the right. Deep.

“Marks consistent with grips, bilateral forearms. Two hands. Significant force. Patient was not the aggressor, but rather the resistor.”

I straighten up, look at her arms for a moment, at the map of what happened in her own skin.

“Moving to the neck.” My greatest advice for new medical examiners and students–the neck and face will tell you everything.

The bruising on Jane’s neck is extensive. Unmistakable patterns. “Petechiae presented bilaterally, tracking toward the jaw and lower orbital region, burst capillaries consistent with sustained pressure and....” Skin here is so delicate that any pressure will cause bruising–but sustained pressure is vastly different. The bruising is dark and angry. “Manual strangulation.”

I let myself see it–hands around her throat. Her own hands coming up, grabbing at wrists, forearms, whatever she can reach. Her nails ripping and catching skin. She looked up at his face, and saw exactly who was doing this to her.

“Proceeding to facial examination.” My hand shakes slightly as I peel open her eyelids. I frown at it, until it steadies. “Petechiae to the left and right eyeball. Again, consistent with strangulation.” When I get to her lips, I note the discoloration at the lips. I’d noticed this initially when I’d retrieved her from the body bag. Cyanotic, yes–expected, consisted with asphyxiation.

But beneath the blue, there is something else… A faint cast I’ve seen before. I lean in close with my light and look for a long time. “Discoloration at the lips inconsistent with strangulation alone. Faint perioral staining. Flagging for tox–possible ingested compound.”

Something she’d eaten. Or drunk. Wine, and the clinking of glasses. A crowded restaurant and the noise that comes with it. A man sitting across from her, pouring her her own glass of the bottle he’d ordered.

Poisoned, and then strangled. “Tox and internal examination will confirm. Patient was likely drugged first. To slow her down.” A woman stumbling down steps, into an alleyway. A man on her heels. “To make her manageable.”

“Proceeding to internal examination, 9:41 AM.” Jane’s sternum is cool beneath my gloves as I make the first incision. Once I’ve sliced all the way down, I begin to open her chest and then… I taste something bitter. Extremely bitter.

It would be a rookie mistake to perform an autopsy without a face mask. I would never make such a mistake. The running water of the autopsy table whisks away any bodily fluids and dead bodies don’t spray, so the only way anything would reach me would be gaseous. I jerk away from Jane’s body, stumbling far enough that I can activate safety protocols. I need to… I stumble on my feet. A sharp pain slices through my chest, and the autopsy room goes dark.

Marcus laughs as he orders from the sommelier. I’ve been on some horrible dates for me to register him not checking out the waitress as a good thing. It’s a nice restaurant for a first date, though I feel like I’ve known him forever. We met online. I know, I know. He was just so nice and sweet… I don’t regret it. “Do you like wine?”

“Oh yes.” I practically bat my eyes at the man, smiling so hard my cheeks hurt.

Marcus laughs again. He has a good laugh–not performative like most men.

I can’t remember the last time I had such a good time. "Tell me about your work," he says, leaning forward, elbows on the table. "I want to know everything."

"You really don't."

"I really do."

So of course, I tell him. Because I always tell people, on dates and at dinner parties and at my mother's kitchen table, because my work is the most interesting thing about me and I know it and I have made a peace with that. I tell him about the cases I can talk about. I tell him about the ones that stayed with me. I tell him, because he asks a very specific and intelligent follow-up question, about the Harmon case. A serial poisoning case with six casualties so far. I tell him that I’ve discovered what the killer used–a sedative typically prescribed for epileptic patients. Midazolam. I tell him more than I should–that this discovery could lead to an arrest because really, very few people are prescribed this as a take-home medication.

He listens the way people rarely listen. Still. Focused. His wine glass halfway to his mouth and then forgotten there.

"That's fascinating," he says, when I finish. "Have you filed the report yet?"

An odd question, I think, briefly. Then I sip more wine and shake my head.

Marcus refills my glass.

The first sign is subtle enough that I almost explain it away.

A heaviness. Not in my head—lower than that, behind my eyes, in my limbs. Like the evening is pressing down on me from the outside. I set my fork down and pick it back up and set it down again.

I'm just tired, I think. I've been working too hard. This is what happens when you work too hard and then have two glasses of wine on a Monday.

"Are you alright?" Marcus asks.

"I'm —" I reach for the word fine and find it further away than it should be. "I think I need some air, actually."

"Of course." He's already standing, already reaching for my coat, already so attentive, so ready, like he knew I was going to say that before I said it.

I think of how considerate that is, and how much my mother will love him. Maybe I am not destined to be single forever. The alley beside the restaurant is where the cool air hits me. Instead of helping like it usually does when I’ve had too much to drink, it does the opposite. The ground lurches. I put my hand against the brick wall, and walk deeper into the alley, walking nowhere in particular. The wall is rough under my hand, and I stare at it for a long moment.

This is not wine.

As educated as I am, I’m a doctor for crying out loud, I should have known that. I turn around.

Marcus is right there, a step behind me. He’s been there this whole time, one hand on the small of my back, guiding, so naturally guiding, me deeper into the alley.

Now, he is looking at me with an expression I have seen before. I have described it in reports, in courtrooms, in testimony, in the clinical language I reach for now and cannot find because my tongue is too thick in my mouth and my legs have lost feeling and my back has hit the dirty ground of this alley.

No visible emotional response. Consistent with–

His hands close around my arms. I pull against him. I find his wrists with my nails and I drag as hard as I can until I feel skin and nails give way. The last sharp, clear part of my mind thinks, “Good, good, that’s evidence. My ME will find that–”

His hands move to my throat. I look at his face the whole time.

I need to remember his face. I need to remember his name. I need to tell someone, somehow, that Marcus Hale is the Harmon Island murderer.

Then nothing.

June 23, 2026 – 7:45 AM

Dr. Yusuf is paged into Dr. Bryant and Dr. Okafor’s lab early in the morning to handle a delivery. “I’m sorry to do this, Dr. Yusuf.” Dr. Okafor apologizes, unlocking the morgue door and leading him in. “Dr. Bryant is unreachable at the moment, and we’ve got another victim of the Harmon case. She is most familiar with it, but this simply cannot wait.”

The younger doctor smiles and assures the older man that she had nothing better to do on a Tuesday morning. She passes Dr. Okafor, and makes her way to the coolers, where a black body bag awaits her. Having studied under Dr. Bryant, she knows her way around this place better than most.

Dr. Okafor mutters a hasty goodbye, and so she gets to work. She gathers the paperwork, and… The autopsy report is already filled out.

Cause of death: Poisoning by Midazolam, manual strangulation

Marcus Hale

Dr. Yusuf’s shaky hands unzip the body bag, stares at her old mentor for a long time, and looks back at the paperwork.

She reaches for her phone.